AN UNUSUAL CASE OF TYPE 2 RESPIRATORY FAILURE

CHEST Journal ◽  
2019 ◽  
Vol 155 (4) ◽  
pp. 88A
Author(s):  
S. Subramaniam
Keyword(s):  
Respiratory Failure ◽  
Unusual Case

scholarly journals An unusual case of aggressive malignant spread of epithelioid hemangioendothelioma

Rare Tumors ◽  
2021 ◽  
Vol 13 ◽  
pp. 203636132110108
Author(s):  
Ashley D Hickman ◽  
Evandro D Bezerra ◽  
Anja C Roden ◽  
Matthew T Houdek ◽  
Jonathan D Barlow ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Soft Tissue ◽  
Multimodal Treatment ◽  
Unusual Case ◽  
Case Reports ◽  
Case Series ◽  
Epithelioid Hemangioendothelioma ◽  
Vascular Neoplasm ◽  
Pulmonary Imaging ◽  
Low Incidence

Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm which typically originates from liver, lung, or bone. Due to the low incidence of disease, the most effective treatment is not easily studied and much of the information known about EHE has been learned through case reports and case series. In this case, we will present an uncommon form of primary soft tissue EHE with local recurrence, bone metastasis, and lymphangitic spread to the lungs leading to respiratory failure. Imaging of the chest was atypical for EHE with intraseptal thickening and hilar lymphadenopathy. Respiratory failure was progressive despite aggressive multimodal treatment. This case highlights an unusually aggressive recurrence and metastasis of primary soft tissue EHE with atypical pulmonary imaging findings.

Interaction between methadone and clarithromycin as the suspected cause of an opioid toxidrome

2021 ◽  
Vol 14 (5) ◽  
pp. e240647
Author(s):  
Blair Wallace ◽  
Daniel Edwardes ◽  
Christian Subbe ◽  
Muhammed Murtaza
Keyword(s):  
Respiratory Failure ◽  
Community Acquired Pneumonia ◽  
Opiate Dependence ◽  
Pleuritic Chest Pain ◽  
Once Daily ◽  
High Importance ◽  
Level Of Consciousness ◽  
The World ◽  
History Of

A 40-year-old patient was admitted through the acute medical take with pleuritic chest pain and rigours. He had a medical history of opiate dependence and was receiving 60 mg of methadone once daily. He was diagnosed with a community-acquired pneumonia and treated with amoxicillin and clarithromycin. After administration of only two concomitant doses of methadone and oral clarithromycin, he developed an opioid toxidrome with type-2 respiratory failure, a decreased level of consciousness and pinpoint pupils. The patient was treated with naloxone and his symptoms improved. Retrospectively, it was suspected that an interaction between clarithromycin and methadone might have contributed to the toxidrome. Respiratory failure has not been previously prescribed for this combination of medication and is of high importance for physicians and pharmacists around the world.

Cutibacterium acnes sternoclavicular joint osteomyelitis in an otherwise healthy 55-year-old man

2021 ◽  
Vol 14 (7) ◽  
pp. e241778
Author(s):  
Sean Yaphe ◽  
Kemal Bahcheli
Keyword(s):  
Unusual Case ◽  
Left Knee ◽  
Sternoclavicular Joint ◽  
Joint Injection ◽  
Cutibacterium Acnes ◽  
History Of ◽  
Haematogenous Spread ◽  
Body Joint ◽  
Full Body

Sternoclavicular joint osteomyelitis is extremely rare, with only 225 reported cases in the last 45 years. We present an unusual case in an otherwise healthy 55-year-old man with a history of well-controlled type 2 diabetes mellitus and hypertension. He presented to the emergency department after a week of left knee pain that worsened to full-body joint pain with left sternoclavicular swelling. He was started on antibiotics with multiple washouts of the left knee and treated for septic arthritis. By MRI and CT, he was found to have left sternoclavicular joint osteomyelitis and abscess and underwent debridement and resection. We believe that the initial joint injection resulted in haematogenous spread to the left sternoclavicular joint, stressing the importance of a sterile field for joint procedures.

scholarly journals Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection

2021 ◽  
Vol 15 (7) ◽  
pp. e0009453
Author(s):  
Sri Linuwih Menaldi ◽  
Anastasia Asylia Dinakrisma ◽  
Hok Bing Thio ◽  
Iris Rengganis ◽  
Salma Oktaria
Keyword(s):  
Septic Shock ◽  
Unusual Case ◽  
Helminth Infection ◽  
Endoscopic Examination ◽  
Course Of Illness ◽  
Source Of Infection ◽  
Helminth Infections ◽  
History Of ◽  
Severe Type

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock–like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)–multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function–specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.

Primary lung abscess due to multidrug-resistant Klebsiella pneumoniae

2021 ◽  
Vol 14 (9) ◽  
pp. e244759
Author(s):  
Mascarenhas Chrystle ◽  
Acharya Vishak ◽  
Kamath Sindhu ◽  
Mendonca Jane
Keyword(s):  
Klebsiella Pneumoniae ◽  
Unusual Case ◽  
Early Recognition ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
Drug Resistant ◽  
Management Guidelines ◽  
History Of

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.

scholarly journals Glycosylated haemoglobin: a false sense of security

2018 ◽  
Vol 11 (1) ◽  
pp. e227668
Author(s):  
Emily Finan ◽  
Joe Joseph
Keyword(s):  
Unusual Case ◽  
Hereditary Spherocytosis ◽  
Reticulocyte Count ◽  
Blood Film ◽  
Glycosylated Haemoglobin ◽  
Sense Of Security ◽  
Peripheral Blood Film ◽  
False Sense ◽  
History Of

We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.

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